Defined consensus statements and corresponding levels of agreement (percentages have been rounded to the nearest decimal place)
| No. | Statement | Strongly agree | Tend to agree | Tend to disagree | Strongly disagree | Agreement |
| Topic A. The role and utility of treatment intensification including the option of chemotherapy in triplet therapy | ||||||
| 1 | There is level 1 evidence that treatment intensification in newly diagnosed mHSPC including doublet therapy (ADT+ARTA) improves PFS and OS vs ADT alone | 53% | 48% | 0% | 0% | 100% |
| 2 | There is level 1 evidence that triplet therapy and early treatment intensification in the form of ADT+docetaxel+ARTA benefits mHSPC patients vs doublet therapy of ADT+docetaxel | 43% | 53% | 4% | 0% | 96% |
| 3 | The evidence for treatment intensification in mHSPC with ADT+ARTA + chemotherapy is based on ARASENS | 41% | 48% | 10% | 1% | 89% |
| 4 | The evidence for treatment intensification in mHSPC with ADT+ARTA is based on TITAN, ENZAMET, LATITUDE, ARCHES and STAMPEDE | 53% | 41% | 5% | 1% | 94% |
| 5 | ADT monotherapy is no longer acceptable standard of care for patients with mHSPC apart from patients in whom ARTA or docetaxel is contraindicated, if the patient is elderly/frail/unfit due to comorbidity or if the patient declines additional treatment | 58% | 29% | 13% | 1% | 87% |
| 6 | Ensuring equity of access across the UK to treatment intensification in appropriate patients is a priority | 68% | 28% | 3% | 0% | 97% |
| 7 | In newly diagnosed mHSPC, the preferred doublet is ADT+ARTA rather than ADT+docetaxel | 32% | 49% | 18% | 1% | 81% |
| 8 | If a patient is offered treatment with docetaxel, then it should be in the context of triplet therapy (ADT+ARTA + chemotherapy) | 30% | 53% | 15% | 2% | 83% |
| 9 | The inclusion of docetaxel to ADT+ARTA provides better overall free survival vs ADT+docetaxel | 42% | 52% | 7% | 0% | 93% |
| 10 | There is evidence that treatment intensification significantly delays time to castration resistance. This is an important consideration in the management of mHSPC | 46% | 52% | 3% | 0% | 98% |
| 11 | Treatment intensification is not associated with significant impact to quality of life at 1 year in clinical trials compared with the comparator arms | 21% | 52% | 25% | 3% | 73% |
| Topic B. Identification of suitable patients to consider for treatment intensification including the option of chemotherapy in triplet therapy | ||||||
| 12 | In metastatic disease, a patient’s prostate cancer is likely to be a determining factor of reduced life expectancy, and treatment intensification with triplet therapy should be considered | 33% | 58% | 8% | 1% | 92% |
| 13 | Most patients should be assessed with a comprehensive multidisciplinary assessment (such as the comprehensive geriatric assessment) to identify suitability for treatment intensification with triplet therapy | 63% | 23% | 13% | 2% | 86% |
| 14 | If a patient’s life expectancy is significantly limited due to comorbidities (<1–2 years), then treatment intensification with triplet therapy may not be appropriate | 54% | 39% | 7% | 0% | 93% |
| 15 | Patients’ fitness should be assessed with treatment intensification of triplet therapy in mind, and optimised in readiness where appropriate and required | 51% | 43% | 6% | 0% | 94% |
| 16 | Age alone is not a criterion for denying treatment intensification with triplet therapy | 52% | 44% | 3% | 1% | 96% |
| 17 | Assessment for frailty and vulnerability is important in determining suitability for treatment intensification | 70% | 28% | 3% | 0% | 98% |
| 18 | Tools such as G8, Charlson Comorbidity Index (CCI), frailty scores should be used in appropriate patients | 32% | 57% | 11% | 1% | 88% |
| 19 | Triplet therapy should be considered in fitter patients for example, ECOG 0–1 | 66% | 28% | 6% | 1% | 93% |
| 20 | Triplet therapy should be considered in patients with high-risk disease (as defined by LATITUDE with having at least two of the three following high-risk factors: a Gleason score of 8 or more (on a scale of 2 to 10, with higher scores indicating more aggressive disease), at least three bone lesions, and the presence of measurable visceral metastasis) | 44% | 48% | 8% | 1% | 92% |
| 21 | Triplet therapy should be the preferred option in patients with high-volume disease who are suitable for chemotherapy, as defined by CHAARTED (presence of visceral metastases or four or more bone lesions with at least one beyond the vertebral bodies and pelvis) | 43% | 51% | 4% | 2% | 94% |
| 22 | Triplet therapy should be considered in patients with low-volume disease that has a significant disease burden (eg, with multiple lymph node involvement) who are suitable for chemotherapy | 24% | 49% | 23% | 3% | 73% |
| 23 | Triplet therapy should be the preferred option in patients with visceral disease (liver or lung metastases) who are suitable for chemotherapy | 48% | 41% | 11% | 1% | 88% |
| 24 | Approximately 30% of newly diagnosed mHSPC patients are potentially suitable for treatment intensification with triplet therapy | 31% | 57% | 12% | 1% | 88% |
| 25 | All newly diagnosed mHSPC patients suitable for triplet therapy should be offered it | 34% | 48% | 12% | 7% | 82% |
| Topic C. The role of patient education and shared decision making | ||||||
| 26 | Identifying and understanding patient goals is critical to the shared decision-making process | 74% | 23% | 2% | 0% | 98% |
| 27 | Shared decision making is vital for decisions regarding treatment intensification in mHSPC | 82% | 16% | 3% | 0% | 98% |
| 28 | Shared decision making improves compliance and adherence to treatment | 75% | 21% | 4% | 0% | 96% |
| 29 | Shared decision making is important in minimising a patient’s post-treatment regret | 77% | 23% | 1% | 0% | 99% |
| 30 | Patient education is important to provide the tools for patients to mitigate or respond to side effects during treatment | 73% | 27% | 1% | 0% | 99% |
| 31 | Patient understanding of the disease and their treatments is important | 73% | 26% | 1% | 0% | 99% |
| Topic D. Multidisciplinary working | ||||||
| 32 | Categorisation of patients by volume and risk should be done for all patients by the MDT | 48% | 44% | 8% | 0% | 93% |
| 33 | The prostate cancer MDT pro-forma should contain all relevant patient details including all comorbidities and functional status | 71% | 26% | 3% | 1% | 97% |
| 34 | Physical and psychological prehabilitation should be an integral part of management of patients with mHSPC | 43% | 48% | 7% | 2% | 92% |
| 35 | Education is an ongoing process of the prostate cancer team and should be integrated into the work programme | 52% | 46% | 3% | 0% | 98% |
| 36 | Multidisciplinary working has been shown to improve outcomes in cancer patients | 60% | 36% | 3% | 1% | 96% |
| 37 | All patients with mHSPC should have a named CNS throughout their prostate cancer journey | 65% | 30% | 5% | 0% | 95% |
| 38 | CNS staffing levels are currently inadequate to provide optimal patient support in prostate cancer | 58% | 33% | 7% | 3% | 90% |
| 39 | Lack of chemotherapy suite capacity should not be a reason in decision making regarding triplet therapy | 48% | 40% | 12% | 0% | 88% |
ADT, androgen deprivation therapy; ARTA, androgen receptor-targeted agent; CNS, clinical nurse specialists; MDT, multidisciplinary team; mHSPC, metastatic hormone-sensitive prostate cancer; OS, overall survival.